A rate filing must be submitted whenever a new policy, rider, or endorsement form that affects benefits is submitted for approval and whenever there is a change in the rates applicable to a previously approved form. The filing must be clearly identified as a small group rate filing.

Small group health plan rates must be filed separately from individual or large group rates. Grandfathered plans must be filed separately from non-grandfathered plans.

All filings must be filed electronically, using the NAIC System for Electronic Rate and Form Filing (SERFF). See http://www.serff.com.

Small group rate filings are subject to approval by the Superintendent unless they are submitted for informational purposes under the “Guaranteed Loss Ratio” section of Title 24-A, § 2808-B, 2-C, A.

If a filing subject to Title 24-A, § 2808-B, 2-B. A. is found to be in compliance with the applicable requirements, the SERFF record will show the rates as “Approved,” and the record will be closed. If a filing subject to Title 24-A, § 2808-B, 2-C. A. is found to be in compliance with the applicable requirements, the SERFF record will show the rates as “Filed for Information,” and the record will be closed.

The name and address of the carrier, HOIS number, NAIC number and the name, title, email address, and direct phone number of the person responsible for the filing, must be provided in the SERFF “Filing Contact Information” section.

List all policy form numbers including HIOS Product Codes and Product Names. Indicate if open to new sales. Include a brief description of the benefits provided by each policy form and any attached riders or endorsements.

Provide the number of group policies, the number of covered employees, the number of covered insureds, and the annualized premium for the Maine policies which will be affected by the proposed rate revision.

This section applies to all hospital and medical “expense-incurred” small group health plan* rate filings subject to prior approval.
*See Title 24-A §2808-B, 1. G. for definition of “small group health plan.”

Every policy, rider, or endorsement form affecting benefits which is submitted for approval must be accompanied by a rate filing or, if the form does not require a change in the premium, the submission must include a complete explanation of the effect on the anticipated loss ratio. The rate filing must include all rates, rating formulas and revisions. Rates for new forms must be filed with the form rather than separately unless included in a general rate filing for all small group products.

The filing must include sufficient supporting information to demonstrate that the rates are not excessive, inadequate, or unfairly discriminatory. Carriers are required to review their experience no less frequently than annually and to file rate revisions, upward or downward, as appropriate. Upward revisions must be filed in a timely manner to avoid the necessity of large increases.

Describe and explain the morbidity basis for the form. Any substantive adjustments from the source or earlier assumptions must be explained. The morbidity assumed must be adequately justified by supporting data.

Display the average annual premium per group certificate for both Maine and all states in which the form is or was sold. If a rate adjustment is proposed, the filing must disclose the average percentage increase a policyholder will experience as well as the largest percentage increase that any in-force policy will receive. The average increase must be determined by comparing the aggregate premium before and after the increase (assuming no lapses) for all policies renewing during the period during which the rates are intended to be in effect. The maximum increase is the largest increase for an in-force policy, including changes due to trend, aging, and changes in demographic, area, industry rating factors, but excluding changes in the covered population under a group policy.

Carriers shall consider experience solely within the State of Maine in developing rates using the single risk pool for all non-grandfathered plans as required by the federal Affordable Care Act (ACA). However, if there is insufficient experience within Maine upon which a rate can be based, the carrier may use nationwide experience using the single risk pool as required by the ACA. In considering experience outside the State of Maine, as much weight as possible must be given to Maine experience to the extent it is credible. If nationwide experience is used, premiums must be adjusted to the Maine rate leveland, where appropriate, claims must be adjusted to Maine utilization and price levels. If premiums incorporate area factors that adjust for variations in utilization and price levels such that adjusting experience to Maine levels would result in the same percentage adjustment to both premiums and claims, then neither adjustment need be made. The carrier in its rate filing shall expressly show what geographic experience it is using. Experience from inception for each calendar year and, where appropriate, each policy year must be displayed, including the following information:

State all the attributes upon which the premium rates vary. If the form is area-rated, a complete table of area factors for all states must be included. Discuss the impact of any changes in geographic factors within Maine.

Subject to rules adopted by the Superintendent, a carrier may vary the premium rate due to occupation and industry (grandfathered plans only), family membership (grandfathered plans only), and participation in wellness programs to the extent permitted by the federal Affordable Care Act.

A carrier may vary the premium rate due to geographic area in accordance with the limitation set out in this paragraph. For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State on or after October 1, 2011, the rating factor used by a carrier for geographic area limited to a ratio of 1.5 to 1.

Notwithstanding the above paragraph, rates with respect to employees whose work site is not in this State may be based on area adjustment factors appropriate to that location.

A carrier may vary the premium rate due to age and tobacco use only under the following schedule and within the listed percentage bands.
For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State after December 31, 2013, the maximum rate differential due to age filed by the carrier as determined by ratio is 3 to 1. The age curve required by ACA must be used for non-grandfathered plans, If a different age curve is used for non-grandfathered plans, it must be filed.

For all policies, contracts, or certificates that are executed, delivered, issued for delivery, continued or renewed in this State on or after October 1, 2011, the maximum rate differential due to tobacco use filed by the carrier as determined by ratio is 1.5 to 1.

The filing must include the index rate for non-grandfathered plans and any formulas or factors used to adjust that rate, including actuarial value and cost sharing, provider networks, benefits in addition to the Essential Health Benefits (EHB), and with respect to catastrophic plans, the expected impact of the specific eligibility categories for those plans. Index rate adjustments for any benefits in addition to EHB must be consistent for all products with same additional benefits. Please include a statement of compliance with this requirement in the actuarial memorandum.

For grandfathered plans, if rates vary by group size, the filing must disclose those factors and provide support based on expected differences by group size. The maximum rate differential due to age and group size combined must not be greater than a ratio of 3 to 1. For non-grandfathered plans, variations by group size are not permitted on or after January 1, 2014.

If a rate adjustment is proposed, the filing must disclose the average percentage increase an employer will experience as well as the largest percentage increase that any employer will receive. The average increase must be determined by comparing the aggregate premium before and after the increase (assuming no lapses) for all policies renewing during the period during which the rates are intended to be in effect. The maximum increase is the largest increase for an employer under a currently in-force policy, including changes due to trend, aging, and changes in demographic, area, industry rating factors, but excluding changes in the covered population.

Rates applicable to grandfathered small employers in association or trustee groups that differ from rates applicable to other small employers are subject to the following:

a. The use of different community rates for the association or trustee group must have been authorized by the Superintendent pursuant to Title 24-A, §2808-B, 2. E.

b. The rate filing must state the percentage by which the rates for the association or trustee group differ from the rates for other small employers. If the difference is not a flat percentage, the filing must state the range of percentage differences and the average percentage.
For non-grandfathered plans, rates must be the same as for non-association small group plans.

Include a certification by a qualified actuary that to the best of the actuary’s knowledge and judgment, the entire rate filing is in compliance with the applicable laws of the State of Maine and with the rules of the Bureau of Insurance. "Qualified actuary," as used herein, means a member in good standing of the American Academy of Actuaries.

HMO rate filings must include a certification by a qualified actuary that the rates are not excessive, inadequate, or unfairly discriminatory, along with adequate supporting information. “Qualified actuary,” as used herein, means a member in good standing of the American Academy of Actuaries.

The filing must include a copy of the form letter to be used to notify policyholders of a rate increase, as required by Title 24-A, § 2839-A, 1. and the date on which the notices were sent. If they have not yet been sent, state the date they are intended to be sent and provide written confirmation to the Bureau when the notices have been sent.
Note: A carrier must provide written notice by mail or electronically of a rate increase to all affected policyholders or others who are directly billed for group coverage at least 60 days before the effective date of any increase in premium rates. An increase in premium rates may not be implemented until 60 days after notice is provided. For small group health plan rates subject to Title 24-A, § 2808-B, 2-B, if the increase is pending approval at the time of notice, the disclosure must state that the increase is subject to regulatory approval.

Notwithstanding Title 24-A, § 2808-B, 2-B, rate filings for a credible block of small group health plans may be filed in accordance with this subsection instead of Title 24-A, §2808-B, 2-B. Rates filed in accordance with this subsection are filed for informational purposes:

A block of small group health plans is considered credible if the anticipated average number of members during the period for which the rates will be in effect meets standards for full or partial credibility pursuant to the federal Affordable Care Act. The rate filing must state the anticipated average number of members during the period for which the rates will be in effect and the basis for the estimate. If the superintendent determines that the number of members is likely to be less than needed to meet the credibility standard, the filing is subject to Title 24-A, §2808-B, 2-B.

The Superintendent shall disapprove any premium rates subject to prior approval, whether initial or revised, for a small group health plan unless it is anticipated that the aggregate benefits estimated to be paid under all the small group health plans maintained in force by the carrier for the period for which coverage is to be provided will return to policyholders at least 75% of the aggregate premiums collected for those policies, as determined in accordance with accepted actuarial principles and practices and on the basis of incurred claims experience and earned premiums.

Filed rates which are applicable to grandfathered small employers in association or trustee groups that differ from rates applicable to other small employers must include justification for the difference in rates. For non-grandfathered plans, rates must be the same as for non-association small group plans.

A rate filing not subject to the guaranteed loss ratio provisions referenced in “G. 9” above, which covers or is expected to cover more than two thousand (2,000) Maine residents is subject to the following:

A. Expenses: Include a description of any expense assumptions used, including, for example, per policy and percentage of premium expense for commissions, other administrative expenses, and profit margin.

B. Investment income: Include an estimate of investment income attributable to the affected policies and how it is reflected in the rates.

All rate filings that would result in a rate increase must include the Federal Part I Unified Rate Review Template and Federal Part III Actuarial Memorandum. Filings that have been identified as “potentially unreasonable” in accordance with the ACA must also include Federal Part II written description of the rate increase.

All rate filings should include the calculated numerical output of the AV calculator, the metal level designation, and the AV inputs used and the document and pages numbers where these can be found in the form filing. If the plan design does not fit into the AV Calculator, carriers must submit an actuarial certification, a detailed description of the alternative methodology used, the calculated actuarial value, and the metal level designation.